| Mustang Family Physicians Pc | |
|
206 N Mustang Mall Ter Mustang OK 73064-5135 | |
| (405) 256-6000 | |
| (405) 256-6001 |
| Full Name | Mustang Family Physicians Pc |
|---|---|
| Speciality | Family Medicine |
| Location | 206 N Mustang Mall Ter, Mustang, Oklahoma |
| Authorized Official Name and Position | Gerald A Amundsen (PRESIDENT) |
| Authorized Official Contact | 4052566000 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mustang Family Physicians Pc Po Box 268945 Oklahoma City OK 73126-8945 Ph: (405) 256-6000 | Mustang Family Physicians Pc 206 N Mustang Mall Ter Mustang OK 73064-5135 Ph: (405) 256-6000 |
| NPI Number | 1881891653 |
|---|---|
| Provider Enumeration Date | 06/27/2007 |
| Last Update Date | 10/22/2007 |
| Medicare PECOS PAC ID | 0244329159 |
|---|---|
| Medicare Enrollment ID | O20071129000703 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1881891653 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 20242 (Oklahoma) | Primary |
| Provider Name | Gerald A Amundsen |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1710989702 PECOS PAC ID: 4880589233 Enrollment ID: I20040216001119 |
| Provider Name | Stephanie Sims |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558786541 PECOS PAC ID: 4688899818 Enrollment ID: I20140702001011 |
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